Formulary
Octreotide: Indications, Dosing, Side Effects and Interactions
Octreotide clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 4 min read
Octreotide: Indications, Dosing, Side Effects and Interactions
Octreotide clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Symptoms associated with carcinoid tumours with features of carcinoid syndrome, VIPomas, glucagonomas**
- **Adult** (By Subcutaneous Injection): Initially 50 micrograms 1-2 times a day, adjusted according to response; increased to 200 micrograms 3 times a day, higher doses may be required exceptionally; maintenance doses are variable; in carcinoid tumours, discontinue after 1 week if no effect, if rapid response required, initial dose may be given by intravenous injection (with ECG monitoring and after dilution).
**Acromegaly, short-term treatment before pituitary surgery or long-term treatment in those inadequately controlled by other treatment or until radiotherapy becomes fully effective**
- **Adult** (By Subcutaneous Injection): 100-200 micrograms 3 times a day, discontinue if no improvement within 3 months.
**Prevention of complications following pancreatic surgery**
- **Adult** (By Subcutaneous Injection): (consult product literature).
**Test dose before use of depot preparation**
- **Adult** (By Subcutaneous Injection): Test dose 50-100 micrograms for 1 dose, test dose should be given if subcutanous octreotide not previously given.
**Acromegaly,Neuroendocrine (particularly carcinoid) tumour adequately controlled by subcutaneous octreotide**
- **Adult** (By Deep Intramuscular Injection Using Depot Injection): Initially 20 mg every 4 weeks for 3 months then adjusted according to response, increased if necessary up to 30 mg every 4 weeks, to be administered into the gluteal muscle, for acromegaly , start depot 1 day after the last dose of subcutaneous octreotide, for neuroendocrine tumours , continue subcutaneous octreotide for 2 weeks after first dose of depot octreotide.
**Advanced neuroendocrine tumours of the midgut, or tumours of unknown primary origin where non-midgut sites of origin have been excluded**
- **Adult** (By Deep Intramuscular Injection Using Depot Injection): 30 mg every 4 weeks.
**Persistent hyperinsulinaemic hypoglycaemia unresponsive to diazoxide and glucose for octreotide**
- **Neonate** (By subcutaneous injection): Initially 2-5 micrograms/kg every 6-8 hours, adjusted according to response; increased if necessary up to 7 micrograms/kg every 4 hours, dosing up to 7 micrograms/kg may rarely be required.
- **Child** (By subcutaneous injection): Initially 1-2 micrograms/kg every 4-6 hours, adjusted according to response; increased if necessary up to 7 micrograms/kg every 4 hours, dosing up to 7 micrograms/kg may rarely be required.
**Bleeding from oesophageal or gastric varices for octreotide**
- **Child** (By continuous intravenous infusion): 1 microgram/kg/hour, higher doses may be required initially, when no active bleeding reduce dose over 24 hours; Usual maximum 50 micrograms/hour.
Cautions
For all somatostatin analogues Diabetes mellitus (antidiabetic requirements may be altered); growth hormone-secreting pituitary tumours can expand during treatment (causing serious complications); insulinoma (increased depth and duration of hypoglycaemia may occur-observe patients and monitor blood glucose levels when initiating treatment and changing doses)
Side effects
For all somatostatin analogues Common or very common Alopecia; appetite decreased; asthenia; cholecystitis; cholelithiasis (following long term use); cholestasis; constipation; diabetes mellitus; diarrhoea; dizziness; gastrointestinal discomfort; gastrointestinal disorders; glucose tolerance impaired (following long term use); headache; hyperglycaemia (long term use); hypoglycaemia; myalgia; nausea; pruritus; sinus bradycardia; vomiting Side-effects For octreotide Common or very common Arrhythmias; biliary sludge; dyspnoea; hyperbilirubinaemia; hypothyroidism; skin reactions; thyroid disorder Uncommon Dehydration Frequency not known Hepatic disorders; pancreatitis acute (after administration); thrombocytopenia Side-effects, further information Administering non-depot injections of octreotide between meals and at bedtime may reduce gastrointestinal side-effects.
Interactions
**Severe interactions:**
- Effect of other medicinal products on Xermelo Short acting octreotide Concomitant administration of short-acting octreotide with Xermelo significantly decreased the systemic exposure of telotristat...
**Other interactions (6):**
- Co-administration of everolimus and depot octreotide increased octreotide C min with a geometric mean ratio (everolimus/placebo) of 1.47.
- Short- acting octreotide should be administered at least 30 minutes after administration of Xermelo if treatment with short-acting octreotide is needed in combination with Xermelo.
- The following substances may enhance and/or prolong the hypoglycaemic effect of repaglinide: Gemfibrozil, clarithromycin, itraconazole, ketokonazole, trimethoprim, ciclosporin, deferasirox,...
- Insulin requirements may be reduced in the presence of medicinal products with hypoglycaemic activity, such as oral hypoglycaemics, salicylates (for example, acetylsalicylic acid), sulpha...
- Octreotide decreases oral absorption of ciclosporin and a 50% increase in the ciclosporin dose or a switch to intravenous administration could be necessary.
- Octreotide/lanreotide may either increase or decrease the insulin requirement.
Pregnancy
Possible effect on fetal growth; manufacturer advises use only if potential benefit outweighs risk.
Breast feeding
Manufacturer advises avoid-present in milk in animal studies.
Hepatic impairment
Manufacturer advises caution (risk of increased half-life in cirrhosis). Dose adjustments Manufacturer advises consider dose reduction-consult product literature.
Medicinal forms
Solution,Injection
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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